One small tweak to the law, one big leap for TB prevention

TB patients sit in a waiting room in a clinic in Khayelitsha, Cape Town.Picture: Sam Clark

TB patients sit in a waiting room in a clinic in Khayelitsha, Cape Town.Picture: Sam Clark

Published Mar 11, 2018

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As we recognise World TB Awareness Day, it is time for us to support a small legislative change that could play a big role in halting the spread of tuberculosis. My proposed change would be to make it mandatory for respirators to be tested to ensure they are fitting properly. The change would bring us in line with developed nations, where this basic step is integrated into health and safety legislation.

A relatively minor amendment to the law would have a major impact on the spread of TB - without dramatically creating a major new burden for companies or the health-care industry.

It is probably just as well to remind ourselves of the challenge that TB presents for South Africa because, in the main, it does not have the media profile of, say, HIV/Aids, cancer or even diabetes.

In fact, South Africa is recognised as one of the countries with the highest burden of TB infections: about 0.8% of the population - or 454 000 people - develop the condition each year. Statistics South Africa says it is the leading cause of death in this country.

The mining, construction and, of course, health-care industries are hardest hit. The financial cost and impact on our health-care system is huge, and we all know just how fragile it is.

More important still, of course, the social and emotional cost is even larger, removing a growing number of people from the economy and causing huge disruptions to family life. In fighting an epidemic of this kind, health workers are very much at the front line.

Of course, they are particularly susceptible to infection, and this constitutes a real issue, especially for a country like South Africa with such a large TB problem.

The World Health Organisation’s Global Tuberculosis Report 2016 reported that almost 10 000 health-care workers globally are infected with TB, with South Africa in the unenviable position of accounting for 21% of the total, second only to China.

There’s a kind of brutal logic to this: high rates of infection in the general population will clearly translate into high rates of infection in those that treat them, unless preventative measures are taken. Luckily, there are such measures, and they are relatively inexpensive and easy to implement, especially when one considers the shortage of health workers.

In preventing the spread of many diseases, physical barriers often play a significant role - and one that is relatively easy to implement.

Dr Adrien Proust was more famous than his writer son in France for many years because he proposed and implemented a cordon sanitaire in 1869 that successfully halted the spread of cholera from India into Europe and Africa.

This principle has been successfully used to contain many outbreaks of infectious disease, most recently to retard the spread of Ebola in West Africa.

TB is already in our midst, so we cannot erect a boundary to keep it out. But we can give individuals a “personal cordon sanitaire” to protect themselves: a properly fitted respirator designed to prevent the entry or exit of airborne viruses.

Many people use surgical masks to protect themselves from airborne diseases, but they are ineffective.

It is essential that the mask forms a seal around the mouth and nose and has a filter that does not permit the transmission of the virus from the wearer, if he or she is infected, or from the external environment.

The US Centre for Disease Control and Prevention (CDC) emphasises the use of respirators as one of the main environmental controls needed to reduce the risk of airborne infection within the health care environment.

The CDC’s website outlines the elements of an effective programme for the control of airborne infections in hospitals and clinics, and among them is the need to select the right kind of respirators and proper-fit testing.

The fit testing should occur not only at the beginning of the programme, but periodically throughout. Respirators should also be inspected and maintained according to the manufacturer’s instructions.

In other words, respirators have a critical role to play in preventing our already small cadre of health workers from TB infection by their patients, provided they are contain the right kind of filter, and that they fit properly.

To ensure the latter, the fit of each individual’s mask must be tested. Two techniques can be used, one qualitative and one quantitative or objective. The qualitative test requires minimal equipment, but it takes around 20 minutes to perform; more if the first respirator is found not to fit properly and a second must be tried. The quantitative test is performed by a piece of expensive equipment, but it is quick and accurate. Both tests are effective, and the best solution will depend on an organisation’s circumstances and the specific business case.

Organisations in many industries are already issuing their employees with respirators.

While their intentions are good, they really could be wasting their money if such initiatives do not include mandatory fitment testing to ensure the products do what they are designed to do.

Let’s work together to get the law changed.

3M will launch its train the trainer fitment testing programme on World TB Awareness Day as part of its ongoing Live Life. Breathe programme.

* Combrinck is a division manager in the Personal Safety Division at 3M, a global science company.

The Sunday Independent 

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